Healthcare Provider Details

I. General information

NPI: 1700540911
Provider Name (Legal Business Name): CHRISTOPHER DE VALLE CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 07/20/2024
Certification Date: 07/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CYPRESS CREEK PKWY
HOUSTON TX
77090-3402
US

IV. Provider business mailing address

21150 CORAL BLOSSOM LN
CYPRESS TX
77433-5913
US

V. Phone/Fax

Practice location:
  • Phone: 281-440-2150
  • Fax:
Mailing address:
  • Phone: 281-913-9240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number21-590
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: